Despite a long list of unknowns, the potential for an innovative partnership between Butler Memorial Hospital and the Veterans Affairs Medical Center is intriguing. And despite the many "ifs" looming ahead of any formalized relationship, both organizations deserve credit for giving a potential joint effort their full attention.

The May 7 announcement from the VA Secretary in Washington that talks between the Butler Veterans Affairs Medical Center and Butler Memorial Hospital should move forward and would be accorded "fast track" status was an encouraging sign. The sort of partnership envisioned for Butler seems perfectly timed with the VA's national review of health care known as CARES (Capital Asset Realignment for Enhanced Services). A well-integrated partnership between the Butler VA and Butler Memorial Hospital could achieve exactly the sort of innovative and efficient system that CARES is targeting.

Without knowing the final configuration, either of physical buildings on the VA campus or of a shared health care arrangement, it is impossible to reach a specific conclusion on this project's viability. But, the general idea of pooling financial and medical resources to provide state-of-the-art health care to the general population as well as area veterans from the same hospital complex is worthy of serious study. Depending on how it was designed, a BMH-VA partnership could provide a national model for other communities across the country to study - and possibly emulate.

While it is still very early in the process, two issues stand out as critical to the feasibility of the project. Will federal bureaucracy of the VA - or even Congress - limit flexibility to a degree that it makes the arrangement less attractive to BMH officials? And, what level of financial support will the federal government, through the VA, provide to build and operate a cooperative facility?

If satisfactory answers to these two questions are determined, the joint effort has much to offer not only BMH and the patients it serves but also veterans throughout the county and surrounding areas. Unsatisfactory answers, or even suspicions of trouble in either area, could quickly drain enthusiasm for the project.

The degree of integration between the two health organizations could range from simply sharing real estate on the VA campus at the low end to being fully integrated at the high end, with a "hospital within a hospital" approach to provide veterans with their own wing or floor within a brand new Butler Memorial Hospital.

Having already partnered on two CAT scanners, BMH and the VA hospital have at least some experience doing innovative deals together. The scope of integration being discussed now would take the partnership concept to an entirely new level. Still, the potential benefits of the project demand serious study.

Beyond the main hospital buildings the likely plan would retain separate facilities for veterans' outpatient care and a separate nursing home building for veterans.

With BMH and the veterans hospital both dealing with aging, out-of-date facilities, the opportunity to share a brand new, state-of-the-art hospital complex should appeal to medical staff, administrators and patients from both organizations. Sharing facilities would offer significant operational efficiencies and cost savings, while at the same time providing the highest quality health care.

With the federal government in the middle of its sweeping re-evaluation and reconfiguration of veterans hospitals around the country, a highly integrated hospital complex in Butler combining health care for veterans with facilities for the public could become a model to be duplicated elsewhere. While this prospect clearly complicates the job for hospital planners and administrators within both BMH and the VA, the potential benefits are worth the extra effort.